Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Sunday, April 22, 2007

Nail guns. It's construction season and in the last three weeks I've seen three nail-gun injuries. This guy above had to be taken to the operating room to remove this nail from his lower thigh. Luckily it didn't hit anything important. The reason I couldn't get it out in ED was that the head of the nail had disappeared deep into the muscle and objects like this are notoriously hard to find without the aid of Xray and the ability to open the wound. In this case it also had to be opened for wash-out as the nail had carried part of this guy's jeans deep into his thigh.

I didn't get a picture of the nail-gun injury that was more impressive than this, but I did take care of a guy who came in with a 2X4 nailed into his index and middle fingers. He was a great patient and sat in the bed without even asking for any pain medicine. I was able, in his case, to digitally block his fingers and remove the nail and the board. He too had escaped permanent injury.

wish we had a c-arm that we could use in the ed. in this case i was worried enough about the posteior neurovascular bundle that i involved vascular and ortho. the ortho doc said there was no way i would have retrieved it as it had punctured the vastus and disappeared into the muscle belly. the guy did fine. thanks for your comment. hey, come work with us!